เกาะหมู

posted on 26 Jan 2008 17:52 by lordgobgab

วันนี้ ผมาพาทุกท่านเดินทางมากับเรือของผมเรามาถึง "เกาะหมู" เกาะที่ผมเคยแนะนำไว้ตั้งแต่เมื่อคราวที่แล้ว

เกาะนี้ค่อนข้างอุดมสมบูรณ์ คุณคงคิดว่าอาจจะสมกับชื่อของมันกระมัง

แต่เหตุที่แท้จริงของชื่อนั้นมีที่มา...................

เรื่องมีอยู่ว่า วันเสาร์ที่ผมอยู่เวร (ก็เวรวั้นนี้นั่นแหล่ะ)

ช่วงบ่ายอ่อนๆของวันเสาร์ แดดอ่อนๆไม่แรงนัก อากาศค่อนข้างดี เพราะมีฝนตกเมื่อวันสองวันก่อน

น้องปี 5 เข้ามาเรียกในห้องพักแพทย์ว่า เด็กห้องพิเศษ 1 หมูติดคอ........

ตามมาด้วยประโยคหลังว่าเขียว!

จึงรีบวิ่งไปดู เด็กเขียวทั้งตัวนอนนิ่ง ยายร้องไห้โฮ

ตอนนั้นก็อึ้ง ยังพอมีสติอยู่บ้างจึงรีบทำ abdominal thrust

ไม่ได้ดูว่าเด็กอายุเท่าไร ตอนนั้นทำหมดทั้ง abdominal thrust

แล้วก็ได้ทำ back blow ไปด้วย ไม่ได้นับว่าทำไปกี่ครั้ง

ตอนนั้นรู้สึกกลัวมาก ภาพแรกที่ผุดเข้ามาในหัว คือ อาจารย์ศรีเวียง...

ระหว่างนั้นก็ตะโกนให้น้องไปตาม ENT

ฟัง heart rate -> 40 ได้ CPR ทำ chest compression ไปด้วย

หลังทำไปได้สักประมาณ  4 รอบ จึงได้ใส่ laryngoscope ยก blade ดู

เห็นก้อนชิ้นเนื้อหมูอุดอยู่ตรง epiglottis พอดี!

เด็กหายใจเฮือก ก้อนชิ้นหมูผลุบเข้าไปใน trachea

ขอ forcep กับพยาบาล จากนั้นได้ทำ abdominal thrust อีกประมาณ 5 ครั้ง

แล้วก็ back blows ได้ยก blade อีกรอบ

คราวนี้ก็เห็นอีกจึงได้ใช้ forcep คีบออกมา

ได้มันหมูชิ้นประมาณ ปลายนิ้วก้อย

หลังจากนั้นได้ช่วยหายใจ hold mask ให้ oxygen

เด็กเริ่มมีสีมากขึ้น heart rate > 100

monitor O2sat ขึ้นมาเป็น 97

หลังจากนั้นเด็กก็รู้สึกตัวร้องงอแง

เหตุการณ์วันนี้ถือว่าน่ากลัวที่สุดตั้งแต่เคยอยู่เวรเด็กมา 

หลังจากนั้น consult ENT plan scope ดูว่ายังมีเหลืออีก?

 

พอสงบแล้ว จึงมาทบทวน basic life support

เพื่อครั้งหน้าใครที่เคยอ่าน "แผนที่เดินทาง" ของผม

จะได้สามารถช่วยชีวิตคนอื่นได้....................

 

จากนั้นผมก็ออกเดินทางต่อไป มุ่งหน้าต่อไปในหมู่เกาะ ในท้องทะเลที่กว้างใหญ่

ผมจะพยายามบันทึกหลายเหตุการณ์ หลายเรื่องราวไว้ที่นี่.

 

- แนบท้ายบันทึกเดินทาง เกี่ยวกับการช่วยเหลือเด็ก Foreign body obstruction -

อ้างอิงจาก Pediatric Basic Life Support 2000 และ Pediatric Basic Life Support 2005

Relief of FBAO in the Responsive Infant: Back Blows and Chest Thrusts

The following sequence is used to clear a foreign-body obstruction from the airway of an infant. Back blows (Fig. 16) are delivered while the infant is supported in the prone position, straddling the rescuer's forearm, with the head lower than the trunk. After 5 back blows, if the object has not been expelled, give up to 5 chest thrusts. These chest thrusts consist of chest compressions over the lower half of the sternum, 1 finger's breath below the intermammary line. This landmark is the same location used to provide chest compressions during CPR. Chest thrusts are delivered while the infant is supine, held on the rescuer's forearm, with the infant's head lower than the body.

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Fig. 16. Infant back blows to relieve complete FBAO.

 

Perform the following steps to relieve airway obstruction (the rescuer is usually seated or kneeling with the infant on the rescuer's lap):

1. Hold the infant prone with the head slightly lower than the chest, resting on your forearm. Support the infant's head by firmly supporting the jaw. Take care to avoid compressing the soft tissues of the infant's throat. Rest your forearm on the your thigh to support the infant.

2. Deliver up to 5 back blows forcefully in the middle of the back between the infant's shoulder blades, using the heel of the hand. Each blow should be delivered with sufficient force to attempt to dislodge the foreign body.

3. After delivering up to 5 back blows, place your free hand on the infant's back, supporting the occiput of the infant's head with the palm of your hand. The infant will be effectively cradled between your 2 forearms, with the palm of one hand supporting the face and jaw, while the palm of the other hand supports the occiput.

4. Turn the infant as a unit while carefully supporting the head and neck. Hold the infant in the supine position, with your forearm resting on your thigh. Keep the infant's head lower than the trunk.

5. Provide up to 5 quick downward chest thrusts in the same location as chest compressions–lower third of the sternum, approximately 1 finger's breadth below the intermammary line. Chest thrusts are delivered at a rate of approximately 1 per second, each with the intention of creating enough of an ‘artificial cough’ to dislodge the foreign body.

6. If the airway remains obstructed, repeat the sequence of up to 5 back blows and up to 5 chest thrusts until the object is removed or the victim becomes unresponsive.

8.4. Relief of FBAO in the Responsive Child: Abdominal Thrusts (Heimlich Maneuver)

Note: Three maneuvers are suggested to relieve FBAO in the child: back blows, chest thrusts, and abdominal thrusts. Back blows and chest thrusts may be alternative interventions for FBAO in children, and international training programs should train providers on the basis of ease of teaching and retention in their community.

8.4.1. Abdominal Thrusts With Victim Standing or Sitting

The rescuer should perform the following steps to relieve complete airway obstruction:

1. Stand or kneel behind the victim, arms directly under the victim's axillae, encircling the victim's torso.

2. Place the flat, thumb side of 1 fist against the victim's abdomen in the midline slightly above the navel and well below the tip of the xiphoid process.

3. Grasp the fist with the other hand and exert a series of up to 5 quick inward and upward thrusts (Fig. 17). Do not touch the xiphoid process or the lower margins of the rib cage, because force applied to these structures may damage internal organs [281, 294 and 295].

4. Each thrust should be a separate, distinct movement, delivered with the intent to relieve the obstruction. Continue the series of up to 5 thrusts until the foreign body is expelled or the victim becomes unresponsive.

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Fig. 17. Abdominal thrusts performed for a responsive child with FBAO.

 

8.5. Relief of FBAO in the Unresponsive Infant or Child

8.5.1. Lay Rescuer Actions

If the infant or child becomes unresponsive, attempt CPR with a single addition–each time the airway is opened, look for the obstructing object in the back of the throat. If you see an object,remove it. This recommendation is designed to simplify layperson CPR training and ensure the acquisition of the core skills of rescue breathing and compression while still providing treatment to the FBAO victim.

8.5.2. Healthcare Provider Actions

Blind finger sweeps should not be performed in infants and children because the foreign body may be pushed back into the airway, causing further obstruction or injury to the supraglottic area [296 and 297]. When abdominal thrusts or chest thrusts are provided to the unresponsive/unconscious, nonbreathing victim, open the victim's mouth by grasping both the tongue and lower jaw between the thumb and finger and lifting (tongue-jaw lift) [144]. This action draws the tongue away from the back of the throat and may itself partially relieve the obstruction. If the foreign body is seen, carefully remove it.

If the infant victim becomes unresponsive, perform the following sequence:

1. Open the victim's airway using a tongue-jaw lift and look for an object in the pharynx. If an object is visible, remove it with a finger sweep. Do not perform a blind finger sweep.

2. Open the airway with a head tilt-chin lift and attempt to provide rescue breaths. If the breaths are not effective, reposition the head and reattempt ventilation.

3. If the breaths are still not effective, perform the sequence of up to 5 back blows and up to 5 chest thrusts.

4. Repeat steps 1 through 3 until the object is dislodged and the airway is patent or for approximately 1 minute. If the infant remains unresponsive after approximately 1 minute, activate the EMS system.

5. If breaths are effective, check for signs of circulation and continue CPR as needed, or place the infant in a recovery position if the infant demonstrates adequate breathing and signs of circulation.

If the child victim becomes unresponsive, place the victim in the supine position and perform the following sequence:

1. Open the victim's airway using a tongue-jaw lift and look for an object in the pharynx. If an object is visible, remove it with a finger sweep. However, do not perform a blind finger sweep.

2. Open the airway with a head tilt-chin lift, and attempt to provide rescue breaths. If breaths are not effective, reposition the head and reattempt ventilation.

3. If the breaths are still not effective, kneel beside the victim or straddle the victim's hips and prepare to perform the Heimlich maneuver abdominal thrusts as follows:

4. Place the heel of one hand on the child's abdomen in the midline slightly above the navel and well below the rib cage and xiphoid process. Place the other hand on top of the first.

5. Press both hands onto the abdomen with a quick inward and upward thrust (Fig. 18). Direct each thrust upward in the midline and not to either side of the abdomen. If necessary, perform a series of up to 5 thrusts. Each thrust should be a separate and distinct movement of sufficient force to attempt to dislodge the airway obstruction.

6. Repeat steps 1 through 3 until the object is retrieved or rescuer breaths are effective.

7. Once effective breaths are delivered, assess for signs of circulation and provide additional CPR as needed or place the child in a recovery position if the child demonstrates adequate breathing and signs of circulation.

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Fig. 18. Abdominal thrusts performed for supine, unresponsive child.

 

 

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